Former DMC neurosurgery residency director: Allegations against program false

Karen Bouffard
The Detroit News

The former director of a troubled Detroit Medical Center training program for neurosurgeons that lost its accreditation earlier this month defended the program and told The Detroit News that allegations against the program were “totally false.”

Dr. Murali Guthikonda, the DMC's chief of neurosurgery and the former program director for the Neurological Surgery Residency Program, blamed a “small group of residents and faculty” for a complaint that alleged violations of a council's standards for accreditation.

Dr. Murali Guthikonda, the DMC's chief of neurosurgery and the former director of a troubled Detroit Medical Center training program for neurosurgeons that lost its accreditation earlier this month defended the program, saying, "I have to clear my name, so that's why I'm doing the interview."

"I think my own assumption is that some of these people thought they would bring about some changes by the ACGME that they may want to see happen, like a different program director, for what reason I don’t know, and I think they got more than what they bargained for," Guthikonda said.

The Accreditation Council of Graduate Medical Education withdrew the program's accreditation following a site visit on Sept. 18. The DMC has said it will appeal the council's decision to withdraw accreditation, which becomes effective on June 30.  

Loss of accreditation is rare for residency programs and jeopardizes the reputations of the DMC and Wayne State University. The DMC's 65 residency programs are solely sponsored by the DMC, but Wayne State holds contracts with the health system to provide academic training for the residents.

The move further exposed how the fractious relationship between Wayne State's School of Medicine and the DMC is affecting health care in Detroit. At least 12 resident physicians are enrolled in the elite program, according to a university webpage that was taken down after the loss of accreditation was made public by The News. 

"I think this never would have happened had this letter not been sent. They (the residents) just are now in shock, they didn’t expect (this) to happen. You know, self-destructive behavior,"  Guthikonda said.

Guthikonda stressed he was speaking on his own behalf and not for the DMC. He  served as the residency program's director for about 15 years before being replaced  Sept. 5 by Dr. Steven Ham, a DMC neurosurgeon listed on the university's website as an assistant professor of neurosurgery at the WSU School of Medicine. 

Guthikonda, who is still involved in teaching the residents, wouldn't say if he stepped down voluntarily from the program's leadership.

"I have to clear my name, so that's why I'm doing the interview," he said.

Doctor defends record 

Allegations in the complaint were outlined in a July 2 letter sent by the Accreditation Council of Graduate Medical Education to Guthikonda, who was then program director, and Dr. Mark Juzych, DMC's designated institutional official for graduate medical education and a professor of medicine at Wayne State University. 

The complaint alleged that DMC resident neurosurgeons were bullied, forced to work excessive hours and discouraged from reporting safety concerns. It's unclear whether any of the raised allegations led to the loss of accreditation.

"The one thing that I want to be on the record to state ... those allegations (were) either taken completely out of context ... or blatant lies," Guthikonda said. "My perception is that a few residents and a couple staff physicians, they have collaborated.

"(A)ll of this is speculation rather than here’s the evidence. ... When I saw the ACGME letter, I was floored because none of it seemed accurate descriptions, with no examples of whatever they’re talking about."

Although the accreditation council's findings aren't yet public, the complaints referred to in the letter claimed an atmosphere of intimidation, overwork and coercion to hide clinical concerns that might have put patient safety at risk.

DMC spokesman Brian Taylor said "we aren’t going to respond to the allegations in the letter."

The complaints accused the neurosurgery residency program of violating rules on the number of hours residents are allowed to work and discouraged them from reporting violations.

It was also asserted that two residents who worked past the maximum number of hours were involved in car accidents after leaving work.

The accreditation council limits the residents' hours to 80 per week, averaged over a four-week period, and requires that transportation be provided to residents too tired to drive home.

"(E)xcept for the occasional exceeding of the hours... 95 % of the times they all stay within the duty hours," Guthikonda contended. "(T)o say that they exceeded the duty hours, and that the program director doesn’t want them reported, is totally taken out of context...

"The comment could have been: Hey, guys, just don’t exceed duty hours, I just don’t want to ever see a report saying that you are exceeding the hours. Does it mean, don’t report? It’s taken out of context completely."

Safety accusation addressed

The July letter also alleged the DMC did not ensure that neurosurgery residents work in a safe and professional environment. According to the letter, a complainant alleged the program's director authorized the return of a resident who had been dismissed over concerns about patient safety, professionalism and communication skills. 

"Allegedly, the dismissed resident has made verbal and written threats, prompting residents to have concerns about their personal safety," according to the July 2 letter.

Guthikonda maintained the decision to allow the resident's return was made by DMC Vice President of Academic and Community Affairs Patricia Wilkerson-Uddyback, who did not respond Thursday to a request for comment. 

"The vice president of academic affairs is my boss. So if Dr. Uddyback says the resident is coming back, I as the program director have to abide by the directions," Guthikonda said.  

The former residency program director would not comment on whether he agreed with the decision. But he disagreed that the program placed the safety of patients or residents at risk. 

"(W)ho in their right mind would allow a compromise of the patient’s care? Because at the end of the day, it is my patient that gets admitted to the DMC, and the residents are providing care under my supervision and direction...," Guthikonda said. 

"Outcomes are dependent on patient care, the techniques and the results, and if I in anyway compromise the patient care by coercing the residents, who would it affect ultimately? It’s the patient and my reputation."

Another allegation involved the accreditation council's requirement that sponsoring institutions have systems for reporting adverse events and unsafe conditions "in a protected manner that is free from reprisal." 

According to the July 2 letter, a complaint alleged that neurological surgery residents "are subjected to intimidation by the program director, who has instructed residents and faculty to not document or report clinical issues, including future issues that may arise with the possible return of a resident who was previously dismissed from the program."

"Allegedly, the neurological surgery program director bullies, intimidates, criticizes, and coerces residents and other members of the care team," the letter stated.

Guthikonda dismissed the characterization.

"That’s an appalling, disheartening character assassination of me to the degree that I don’t even have a description for that," he said. "Because the comments that I hear from many people is that this is the most benign program in the country that they have ever been to...

'Lack of institutional support'

Neither Wayne State University nor the DMC would release the decision letter from the Accreditation Council of Graduate Medical Education, so it's impossible to know why accreditation was withdrawn. 

But Guthikonda suggested that discord between the university and DMC may have damaged the council's confidence in the program's foundation. 

The accreditation council would not comment on the results of its investigation or its reasons for withdrawing the program's accreditation. 

Though Guthikonda said he didn't see the council's decision letter, since he is no longer program director, he has learned that the move was made due to "lack of institutional support" for the residency program.

He wasn't sure what would constitute lack of institutional support, but speculated that it might be that neurosurgeons weren't given academic titles by Wayne State such as professor or assistant professor.

"Just because you have a title, that should not have mattered at all to the resident teaching," Guthikonda said. "Because if I’m the same person teaching, whether I have a title behind me, or not a title behind me, there is no difference in the teaching."

The hundred-year relationship between Wayne State and the DMC was nearly severed last spring before they reached an agreement to continue. Both the university and the health system have sought partnerships with other institutions, with some success.

Wayne State University has been on a roller coaster of controversies. 

After several WSU doctors accused the university earlier this year of skimming money that was owed to them, the FBI approached several people, two sources told The News.

Wayne State University gave an ultimatum earlier this month to all 110 pediatricians who work for its medical school and Children's Hospital of Michigan: Join the new WSU pediatrics group or lose your jobs with the university in December.

Did bankruptcy play a role? 

Problems with the neurosurgeon residency program may have originated in part with the departure of faculty doctors from the University Physicians Group when the group practice — which represents hundreds of faculty physicians — declared bankruptcy in November 2018.

Judge Mark Randon of U.S. Bankruptcy Court in Detroit approved UPG's Chapter 11 reorganization in June.

Guthikonda said he left UPG in November 2018, and was employed by the DMC, along with three other teaching physicians in the neurology residency program. Neither Guthikonda nor the three other neurosurgeons retained their faculty titles.

Asked if their faculty contracts were terminated, Guthikonda would not comment. But Wayne State University Medical School Dean Dr. Jack Sobel said he did not renew their faculty contracts after they signed on with the DMC. 

There were six faculty members in the neurosurgery department, Guthikonda said. But when four left to work for the DMC, "there were no longer enough members left in the department to keep it as a viable (university) department," he said.

The remaining two faculty neurosurgeons left the university and DMC for other positions, Sobel and Guthikonda said. So no faculty neurosurgeons remain with the neurosurgery residency program.  

"(T)he fact of the matter is all we did was leave from the University Physicians Group to the Tenet environment," Guthikonda said, referring to the DMC's corporate owner. "We all had faculty appointment until last year, November of 2018. Since then we have had no faculty appointments."

Twitter: @kbouffardDN